How to best address the challenges of mental health in medical education? / ¿Cómo enfrentar de la mejor manera los desafíos de la salud mental en la educación médica?

Editorial.

Editorial.

Reduction of catheter-associated bloodstream infections: Effectiveness of the continuous quality improvement method at a university hospital in Colombia / Reducción de las infecciones del torrente sanguíneo asociadas a catéter: efectividad del método de mejora continua de la calidad en un hospital universitario en Colombia

Abstract Introduction: Central Line-Associated Bloodstream Infections (CLABSI) are preventable and potential fatal events, frequent in critical patient care. By mid-2018 an increase was noted in the incidence rate of CLABSI at a high complexity institution in Colombia, demanding immediate interventions to lower those numbers. Objective: To assess the effectiveness of the continuous quality improvement methodology (CQI) to lower the incidence rate of CLABSI at a university hospital in Bogotá, Colombia. Methods: Longitudinal, prospective study implementing a multifaceted intervention in accordance with the CQI methodology. The project was developed at a high complexity university hospital in Bogotá, Colombia, between July 2018 and December 2019. A root cause analysis was consecutively conducted prioritizing contributing factors, gathering ideas for improvement, building a strategy and prioritizing the implementation plan. Results: The CQI methodology enabled the identification of areas susceptible of catheter insertion and management errors at the institution; additionally, it allowed for the prioritization of the areas requiring intervention through consecutive test cycles for improvement ideas. The reduction and sustainability of insertion-related CLABSI was accomplished three months after the start of the interventions, achieving a zero value. The implementation of improvement ideas aimed at reducing the events associated with catheter maintenance was also able to reduce the incidence to zero, until the end of the period of observation of the study. Conclusions: It is feasible to implement CQI in settings similar to the one herein described, in order to efficiently reduce CLABSIs.

Resumen Introducción: Las infecciones del torrente sanguíneo asociadas a catéter (ITS/AC) son eventos prevenibles y potencialmente fatales, comunes en el contexto del cuidado de pacientes críticos. A mediados de 2018 se presentó un incremento en la tasa de incidencia de ITS/AC en una institución colombiana de alta complejidad, obligando a realizar intervenciones inmediatas para lograr una reducción de estas cifras. Objetivo: Evaluar la efectividad del método de mejoramiento continuo de la calidad (MCC) para la reducción de la tasa de incidencia de ITS/AC en un hospital universitario en Bogotá, Colombia. Métodos: Estudio longitudinal, prospectivo, en el que se implementa una intervención multifacética siguiendo la metodología de MCC. El proyecto se desarrolló en un hospital universitario de alta de complejidad de Bogotá, Colombia, entre julio de 2018 y diciembre de 2019. Se realizaron consecutivamente un análisis de causa raíz, priorización de factores contribuyentes, recuperación de ideas de mejora, construcción de la estrategia y priorización del plan de implementación. Resultados: El método de MCC permitió la detección de zonas susceptibles de presentación de errores en la inserción de catéteres y su mantenimiento en la Institución, además permitió priorizar las áreas por intervenir mediante ciclos consecutivos de prueba para las ideas de mejora. Se logró la reducción y sostenibilidad de la ITS/AC asociada a inserción luego de tres meses de iniciar las intervenciones, logrando valores de cero. La implementación de ideas de mejora dirigidas a reducir los eventos relacionados con el mantenimiento de catéteres también logró reducirlos a cero hasta la terminación del periodo de observación de este estudio. Conclusiones: Es factible implementar MCC en contextos como el aquí presentado para reducir de manera eficiente las ITS/AC.

Patient safety as a public health problem / La seguridad del paciente como problema de salud pública

Abstract Patient safety is an essential component of quality healthcare, which is what the general population is constantly demanding worldwide. Consequently, ensuring quality healthcare should not be a matter of clinical interest only but a public health priority so that all actions planned or implemented may have an impact at all levels and ensure intersectoral support to help the population remain safe when seeking and receiving health services. The definition and implementation of patient safety are currently circumscribed to the institutional setting. This article aims to present data that can help put into perspective the existing gaps pertaining to patient safety definition and fields of action, and conclude that there is room to work in public health in order to close those gaps. This requires understanding the complexities of the interactions between determinants of harm outside the physical setting where care is provided. These include community-level work, incorporation of knowledge from other disciplines in order to account for coverage, access and health outcomes, design strategies to counteract the impact that the absence of effective patient and people safety measures have on the general population and, in particular, on people differentially affected by the social determinants of health.

Resumen La seguridad del paciente es una parte esencial de la calidad de la atención sanitaria, que demanda de manera constante la población general en los servicios de salud en todo el mundo. Por ello, su garantía es un deber que no debe ser exclusivo del ámbito clínico, sino una prioridad en salud pública, para que las acciones que se planeen e implementen puedan influir en todos los niveles y se cuente con un sostén intersectorial que favorezca el mantener segura a la población mientras busca y recibe atención sanitaria. La definición y el campo de acción actual de la seguridad del paciente están limitados al ámbito institucional. En este artículo se pretende exponer algunos datos que ponen en perspectiva las deficiencias actuales en la definición y campos de acción de la seguridad del paciente y concluir que en la salud pública hay espacio para trabajar y subsanar estas deficiencias, entendiendo las complejidades de las relaciones entre determinantes de los daños por fuera del espacio físico donde ocurre la atención, desde el trabajo con las comunidades, incorporando conocimientos de otras disciplinas que den cuenta sobre el aseguramiento, el acceso y los resultados en salud, facilitando la evaluación de estrategias que mejoren el impacto que la falta de medidas efectivas de seguridad del paciente y las personas tienen en la población general y especialmente para aquellos que se encuentran afectados diferencialmente por los determinantes sociales de la salud.

Health literacy interventions in the hospital setting: an overview.

Health Literacy (HL) is the degree to which an individual has the ability to find, understand and use information and services to inform health-related decisions and actions. These decisions and actions take place mainly in hospitals, so in this setting, HL has a higher impact on the health status and prognosis of patients. The objective of this study was to identify HL interventions implemented in the hospital care setting and describe the characteristics of their implementation, as well as their impact on health outcomes and care processes of these patients. An overview of systematic reviews published from 2015 to 2020 in MEDLINE (Ovid), Embase, Scopus, Cochrane Database (Ovid), PsyArticles, LILACS (Bvs) and Epistemonikos was conducted. The synthesis of the results was carried out narratively and the methodological quality of the reviews was evaluated using the AMSTAR II tool. A total of 16 reviews were included for full analysis, of which 68.5% were assessed as having high or moderate quality. HL interventions were based on single or multifaceted strategies, including the use of brochures, visual aids, digital tools, multimedia resources (videos) and group and personalized counseling sessions. Despite the high heterogeneity of data, HL interventions seem to have a positive impact on improving health-related knowledge levels and some health-related behaviors and attitudes. In conclusion, it was evidenced that HL interventions implemented in the hospital setting are widely varied. These interventions can be used to improve health-related knowledge levels and promote health-related behavioral changes in inpatients. However, it is necessary to standardize the reporting of both the characteristics and outcomes of these interventions to favor their replicability.

Evaluation of the implementation of the Clinical Practice Guidelines. A pending assignment in Colombia / Evaluación de la implementación de las Guías de Práctica Clínica. Una tarea pendiente en Colombia

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Mechanical ventilator purchases in Latin-American countries: did we make the correct decisions during the COVID-19 pandemic? / Compra de ventiladores mecánicos en países de América Latina: ¿Tomamos las decisiones correctas durante la pandemia de COVID-19?

RESUMEN Objective To establish the purchase price, authorization strategies, availability of health registrations and technical specifications for the purchase of mechanical ventilators in Latin America during the COVID-19 pandemic. Methods A health technology assessment was conducted by searching for technical specifications, health registrations and safety information on mechanical ventilators purchased by nine Latin-American countries including Colombia, Guatemala, Mexico, Argentina, Uruguay, Costa Rica, Brazil, Paraguay, and Peru. Based on the information of 129 tenders and contracts, technical information was obtained from the websites of 32 suppliers and manufacturers, covering 55 different models of mechanical ventilators. This information was compared to the World Health Organization's technical specifications for mechanical ventilators. Information on the availability of health registrations and safety of ventilators was obtained from searching the websites of the sanitary agencies of the nine countries. Information was recorded in a form designed by the researchers. Results In the purchase of mechanical ventilators, significant differences were found in prices, depending on the date of acquisition. Several devices were identified as being non-compliant with some of the technical criteria established by the World Health Organization. Conclusions Access to information on contracts for the purchase of mechanical ventilators is limited, both in terms of access and public consultation. Complete technical information must be required from manufacturers and suppliers and information gaps should be avoided, especially for public purchasing processes.

ABSTRACT Objetivo Establecer el precio de compra, estrategias de autorización, disponibilidad de registros sanitarios y especificaciones técnicas para la compra de ventiladores mecánicos en América Latina durante la pandemia por COVID-19. Métodos Se realizó una evaluación de tecnologías sanitarias mediante la búsqueda de especificaciones técnicas, registros sanitarios e información de seguridad de los ventiladores mecánicos adquiridos por nueve países de América Latina (Colombia, Guatemala, México, Argentina, Uruguay, Costa Rica, Brasil, Paraguay y Perú). Con base en la información de 129 licitaciones y contratos, se realizó una búsqueda de información técnica en los sitios web de los proveedores y fabricantes de 32 marcas y 55 modelos diferentes. Esta información se comparó con las especificaciones técnicas de la Organización Mundial de la Salud para estos dispositivos. La información sobre la disponibilidad de registros sanitarios y la seguridad de los ventiladores se obtuvo de la búsqueda en sitios web de las agencias sanitarias de los nueve países. La información se registró en un formulario diseñado por los investigadores. Resultados En la compra de ventiladores mecánicos se encontraron diferencias significativas en los precios, según la fecha de adquisición. Se identificaron varios dispositivos que no cumplían con algunos de los criterios técnicos mínimos establecidos por la Organización Mundial de la Salud. Conclusiones El acceso público y la información sobre los contratos realizados para la compra de ventiladores mecánicos son limitados. Se debe exigir información técnica completa a los fabricantes y proveedores y se deben evitar los vacíos de información, especialmente para los procesos de compras públicas.

A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America.

Objective: To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods: The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results: Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions: Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.